Why are we idiots about taking care of our health?

Part of the reason is that we don't always think about what we're doing.

Faced with a risk of communicable diseases, humans tend to be very responsive, altering their behavior and taking preventative measures. There are well understood risk factors for things like Lyme disease and hantavirus, and many people have managed to change their habits to minimize risk. Faced with the risk of a noncommunicable disease, like cancer or heart disease, we don't tend to do nearly as well, even when the risks are equally well understood.

Why are we so lousy at simple things like eating well and avoiding cigarettes? A perspective in this week's Science (part of a series on noncommunicable diseases) suggests we've been going at the problem all wrong. In general, we've been asking people to step back and think about things like eating well. But the authors of this piece point out that a lot of our problems take place precisely when we're not bothering to think. And the only way around that issue may be a bit of social engineering.

Many approaches to public health are based on what has been called the deficit model, which assumes that people just don't know enough about the risks associated with problematic behavior. If we just get them enough information, and maybe provide a bit of encouragement, then they'll stop smoking. Or hit the salad bar. Or do whatever is necessary to reduce their health risks.

It doesn't work that way. "To date, interventions aimed at changing such behaviors have largely encouraged people to reflect on their behaviors," the authors write. "These approaches are often ineffectual, which is in keeping with the observation that much human behavior is automatic, cued by environmental stimuli, resulting in actions that are largely unaccompanied by conscious reflection."

The problem, as the authors outline it, is that careful consideration takes time and energy, and most people don't have a lot of either to spare. And when we're not consciously thinking about our actions, we tend to give in to bad habits or various forms of self-gratification.

But it's precisely because we're not bothering to think about things that we are left wide open to subtle manipulation. The authors cite a variety of studies that have shown very subtle changes can get people to make healthier choices. Having more stairs and making them more obvious will mean more people take them. Placing the healthier choices at salad bars closer to the edges gets more people to select them. And so on.

New York City has actually provided a prime example of how this can play out in the real world. Education programs about the health risks of smoking have existed for decades. But, over the span of a few years, the city banned smoking in public places and raised the tax on cigarettes dramatically (it also made it much easier to enroll in cessation programs). By raising the barrier to bad habits and turning the choice of buying a pack of cigarettes into something that people were consciously aware of, the city managed to dramatically reduce smoking rates.

Now, it's attempting to do the same with sugared drinks by putting a limit on the size of sweetened beverage servings. Since people will tend to buy one of whatever's available, the policy will almost certainly cut down on the amount of sugar consumed in the city, which is likely to have an effect on obesity and all the health problems associated with it.

Compared to some methods advocated in this perspective, modifying soda sizes is a relatively hands-off approach. For example, to get people more exercise, the authors suggest we might "consider making the elevator a less appealing option by increasing the effort required to use it. For example, slowing down the speed at which elevator doors close, thus increasing the journey time, increases stair use." In other words, making the experience annoying may be the best way to get people to change their habits.

But there's already a backlash against the (relatively minor) social engineering involved in the soda policy. Some of this is push-back from commercial interests like soda distributors; the authors recognize that these sorts of behavioral efforts pose a threat to "economies that are built on excessive consumption."

Not all of this is economic self-interest, however. These rules can obviously be viewed as providing a benefit to the city's residents, both in terms of health and in terms of reducing the social burden of medical costs. But people can reasonably disagree over how aggressively the government should pursue those benefits at the expense of making everyday life a bit more annoying for some of its residents.

Faced with the risk of a noncommunicable disease, like cancer or heart disease, we don't tend to do nearly as well, even when the risks are equally well understood.

"Equally well understood" within the medical community, maybe. The general public gets bombarded with daily "X causes cancer" panic stories and "Y prevents heart attacks" sales pitches, where the values of X and Y change constantly.

New York City has actually provided a prime example of how this can play out in the real world. Education programs about the health risks of smoking have existed for decades. But, over the span of a few years, the city banned smoking in public places and raised the tax on cigarettes dramatically (it also made it much easier to enroll in cessation programs). By raising the barrier to bad habits and turning the choice of buying a pack of cigarettes into something that people were consciously aware of, the city managed to dramatically reduce smoking rates.

-- ScienceDaily (July 14, 2011) — Raising taxes on cigarettes, a public health measure used by -- governments to encourage people to quit, doesn't motivate all smokers to stop the deadly habit.

-- A study on the long-term impact of taxing cigarettes, led by two Concordia University -- economists and published in the International Journal of Environmental Research and Public-- Health, found higher taxes do prompt low-and middle-income earners to quit.

-- Low-income New York City smokers are getting gouged. Science's number one point -- about smoking is: don't. We all know it's incredibly unhealthy and leads to all sorts of-- nasty cancer. But still, you have to feel for addicted smokers living in New York City,-- where cigarettes cost $14 a pack, give or take. New data collected by RTI shows that-- low-income New York City nicotine fiends spend a quarter of their income on cigarettes-- alone. That's about twice the national average, due in large part to New York state and-- city cigarette taxes, which are the highest in the country. Much of that money goes to-- noble causes such as cancer research, but some wonder if cigarette taxes place too-- high of a burden on low-income residents. "Although high cigarette taxes are an effective-- method for reducing cigarette smoking, they can impose a significant financial burden-- on low-income smokers," says lead author Matthew Farrelly. [Chicago Tribune]

Good idea. Let's tax all medically proven unhealthy items. Obviously this list of items should change gradually as scientific evidence changes. Honestly, if your willfully chosen bad health style is going to tax publicly funded health systems, those systems should get reimbursed by you. And if you think, "I'm not going to use those health systems when I get sick", think about saying that as you're clutching your chest in the middle of the street expecting paramedics to save you "for free".

Alternately, is it possible people have simply considered the risk/rewards, and determined that "living forever" isn't the only thing of importance in life?

I ride motorcycles. I fly small airplanes. I bicycle on streets that have cars. I eat steaks. I drink (good) beer. I enjoy good whiskey. I smoke a pipe or cigar on occasion.

I happen to enjoy all of these. Do they raise my risk of early death over driving everywhere in a Volvo, being a vegetarian, never drinking alcohol, never smoking a pipe? Yes. Am I OK with this? Yes, I am. I'd rather enjoy life and die a few years earlier than be miserable and theoretically live a few years longer in a nursing home.

Further, there's no guarantee that "doing everything right" will lead to a longer life. Maybe you get hit by a freak lightening strike. Maybe you get hit by a truck.

Good idea. Let's tax all medically proven unhealthy items. Obviously this list of items should change gradually as scientific evidence changes. Honestly, if your willfully chosen bad health style is going to tax publicly funded health systems, those systems should get reimbursed by you. And if you think, "I'm not going to use those health systems when I get sick", think about saying that as you're clutching your chest in the middle of the street expecting paramedics to save you "for free".

I guess my concern is really over who gets to make the decision over what is healthy and what is not. Today it's cigarettes and soda. Most people are likely in agreement that these things are bad for us.

But tomorrow, what if some city decides that high fat foods are bad for us therefore does something to encourage low fat options. Sounds reasonable right? Except low fat varieties are often far worse for you. Today's USDA food plate/pyramid is a great example of a very big mistake from our past that some say is one of the major causes of obesity. This is subjective, I get it. My point is really that we need to be careful to ensure that we have 100% rock solid scientific evidence before making claims about what is healthy and what is not. Whole grains at the base of the food pyramid has little science backing it up.

It's a slippery slope and I fear that by having "success" with cigarettes may lead us into much more controversial measures in the future.

I guess my concern is really over who gets to make the decision over what is healthy and what is not.

It doesn't really matter, as long as it's "Not You." Medical experts, elected officials, whoever... as long as it's Not You making the decisions, they're clearly better for you, since you don't know enough to make proper decisions on your own.

We get a lot off conflicting information. Cholesterol is bad. Except HDL cholesterol. But it's bad, so you need to limit intake. Except it's easily regulated, so you don't need to worry much.

The medical industry likes one-size-fits-all solutions, which works poorly. BMI are probably the most obvious issue, but it occurs across the board

Well, and the medical industry needs some degree of protection from idiots. Going to the doctor for antibiotics every time you have a 2-degree fever is ultimately a bad idea. You'd be better off letting your immune system handle it if possible. Which isn't to say going to the doctor when you get a fever is necessarily bad, just don't get all pissy when he tells you to go home, drink water, and eat a simple diet.

The medical industry likes one-size-fits-all solutions, which works poorly. BMI are probably the most obvious issue, but it occurs across the board

This. According to the BMI chart i need to lose 100 pounds. I would have to lose a limb in order to lose 100 pounds, ive got maybe 30-40 pounds on my waste that need to leave, but i can really see the spare tire im lugging around being more than that.

There's a much simpler explanation for people's less-than-optimally-healthy choices: There is more to life than maximizing its length. Most people want to live longer, but they also value other things: convenience, taste, and freedom from effort, for example. So they make trade-offs.

Medical researchers can't measure the pleasure of an extra helping of spaghetti or a cigarette, but they can measure an extra year of life, so only the latter gets counted as a benefit. They observe that in real life most people don't make choices that maximize years, and conclude that most people are "idiots" (your headline) who need nudging from wise academics and bureaucrats to act in their own self-interest.

Saying that the risks involved in something like lyme disease and the risks involved in eating a "poor" diet are "equally well understood" is incredibly dishonest. And that's even if we assume the comedy epidemiology involved in most lifestyle health issues has value. We even have dietary intervention studies that show no link between diet and cancer or diet and life expectancy. A far better for of evidence.

Don't get me wrong, epidemiology was a great tool in showing the risks of smoking. But the correlation shown was much much larger than anything we've seen elsewhere.

And we haven't even addressed what level of risks a person should have the right to accept.

But blaming people for their health situation is such an important part of modern culture I suppose I'm just pissing in the wind.

Good point. One size fits all advice is probably dangerous. I also think it's kind of a luck of the draw when you go see a doctor.

Dr. A may be a "plant based" vegan and do everything in his/her power to get you eating that way.Dr. B may be Paleo and tell you to eat tons of animal products and zero processed foods/grains.Dr. C may just prescribe you a drug.

Each of these Dr's probably believe their approach is best, but it is not one size fits all. How can people properly get matched up with the best approach for their condition?

the authors suggest we might "consider making the elevator a less appealing option by increasing the effort required to use it. For example, slowing down the speed at which elevator doors close, thus increasing the journey time, increases stair use."

I can attest that this is true in my case at least. My apartment is 6 floors up, but since the two elevators are the slowest in the universe (they certainly compete with Mass Effect's elevators for that "privilege"), I actually do end up taking the stairs a fair bit more than I used to in my old building, when I only lived 3 floors up.

The problem is the grey line between deterring bad behavior and violating people's civil liberties. Ex: NYC actions against tobacco (make it more expensive, more difficult to smoke, thus smokers pay a higher price) vs soda (making it less available, thus taking the choice away?)

There's a much simpler explanation for people's less-than-optimally-healthy choices: There is more to life than maximizing its length. Most people want to live longer, but they also value other things: convenience, taste, and freedom from effort, for example. So they make trade-offs.

Right. And inevitably the government gets involved because, despite the trade-offs they think they're making, people ultimately want bad habits that make them feel good AND long life subsidized by the government. I can't think of anyone who can honestly say to themselves, "I lived a great life treating my body like crap. But, I'm dying right now as a result and I have no money to save myself. Meh, I don't care. I lived a good life. It was a good tradeoff".

Instead, I hear everyone say, "Despite all the crap I did to my body, I now want to save my life. But, I can't pay for it. Help me, government!". Financially speaking, asking (or demanding for help) from the public can't work indefinitely. Costs will have to be absorbed somewhere by somebody.

It's better to do it now by taxing those people that want to have that "fuller life" so that support will be there for them when they demand the public for help by age 55+. Maybe "taxing" is the wrong word. It should be more like retirement medical fund for your inevitable health costs.

The medical industry likes one-size-fits-all solutions, which works poorly. BMI are probably the most obvious issue, but it occurs across the board

This. According to the BMI chart i need to lose 100 pounds. I would have to lose a limb in order to lose 100 pounds, ive got maybe 30-40 pounds on my waste that need to leave, but i can really see the spare tire im lugging around being more than that.

BMI is actually fairly accurate unless you're built like a linebacker. Body fat percentage is of course much more accurate but is much harder to determine compared to BMI. I used to think the same thing, I was slightly overweight according to the BMI scale and I thought I only had 20 pounds to lose at most, 25lbs lost later I still have at least 10lbs more to go.

Alternately, is it possible people have simply considered the risk/rewards, and determined that "living forever" isn't the only thing of importance in life?

I ride motorcycles. I fly small airplanes. I bicycle on streets that have cars. I eat steaks. I drink (good) beer. I enjoy good whiskey. I smoke a pipe or cigar on occasion.

I happen to enjoy all of these. Do they raise my risk of early death over driving everywhere in a Volvo, being a vegetarian, never drinking alcohol, never smoking a pipe? Yes. Am I OK with this? Yes, I am. I'd rather enjoy life and die a few years earlier than be miserable and theoretically live a few years longer in a nursing home.

Further, there's no guarantee that "doing everything right" will lead to a longer life. Maybe you get hit by a freak lightening strike. Maybe you get hit by a truck.

So, perhaps, there's more to life than "living longer."

Let's be honest, this is the Goverment we're talking about. They don't really care if you live longer. That costs them more in Social Security, etc.

They simply want to cut medical costs. Period. If you die early or late, that doesn't matter. If you cost lots more in your last 5-10 years due to the cancer, heart attack, etc., then that's a problem.

Nature programmed us this way. Nature used to provide us a certain diet based on where you lived. Some folks didn't have access to fruit year-round, or processed grains (or any grains), or ate more seafood, or ate more dairy. We didn't have to think about our eating choices, b/c millenia of evolution tailored races to thrive on the diets nature provided for them.

Now, we can go to the grocery store and buy anything we want whenever we want ... cake, cookies, candy, fruit, grains, meat, fats/nuts ... things that used to be seasonal or special-occasion foods. Some folks have bodies that haven't adapted to having full-time access to that crap. Hence we have greater occurrences of hyperinsulinemia and trickle down illnesses it can cause. We have higher instances of food allergies...to nuts, seafood, etc.

Folks didn't have to think about what they used to ate; nature just provided. Now you fly half-way across the world, and you face a diet your body may not be familiar with. Suddenly you have to make conscious decisions about what you eat. Most of us are not programmed like that. Most are programmed to eat whatever tastes best, b/c our bodies were programmed to gobble up sugar when it was seasonally available. Then we get short-circuited and just overload on things nature didn't provide all the time in the past.

Same could be said for why people litter. We evolved just throwing food scraps, organic garbage, and relieving ourselves on the ground. Now we have items which don't biodegrade in nature well. We have to make a conscious decision to throw things away in a waste disposal bin instead of chucking it on the ground. But, our basic instinct still prevails at time, and ... down goes the plastic cup on the ground.

The problem is the grey line between deterring bad behavior and violating people's civil liberties. Ex: NYC actions against tobacco (make it more expensive, more difficult to smoke, thus smokers pay a higher price) vs soda (making it less available, thus taking the choice away?)

I don't know much about the NYC soda law. But, aren't there a crazy amount of loopholes a consumer can use to get around this? For example, free 16oz refills, pay for 2 16oz drinks, etc. I don't see how your choice can get taken away. If you want to really drink a lot of soda, there should be lots of options.

The Chicago Tribune just published a story on a report on the NYC cigarette tax and that it, apparently, has not deterred smokers in lower income classes:

Quote:

Poor smokers in New York State spend about a quarter of their entire income on cigarettes, nearly twice as much as the national average for low-income smokers, according to a new study.

The study, conducted by the non-profit research group RTI on behalf of the state's health department, found there was no statistically significant decline in the prevalence of smoking among poorer New Yorkers between 2003 and 2010, even as the habit declined by about 20 percent among all income groups.

Which could indicate that there are other factors at play, at least in cigarette use. It could be any number of things ranging from the education/advertising not getting to them, lack of other options, lack of readily-available cessation programs, etc. Or it could be that it's one of the few still-affordable pleasures that they have. (While technically not a pleasure as some might define it, nicotine does have an effect on the brain that cause a pleasurable correlation.)

Additionally, I'm also a little confounded because often "science" is wrong or hyperbolic (granted, it could be the reporting agencies). I still remember when it was alleged that toothpaste could cause cancer or that yellow mustard could cause cancer. There was also the correlation between eggs and cholesterol that basically was blasted as "eggs will kill you". Now, that's changed. Ditto for salt. Ditto for the "junk genes" theory that has recently been debunked.

IOW, historically, scientifically recommended healthy choices (barring some very strong ones like smoking and cancer), have not proven to withstand the test of time. Granted, as science is able to learn more and more specifically, it will eventually get better. But there is no valid "one size fits all" approach when it comes to health and making healthy choices.

However, it could be vastly improved by education beginning in schools and, especially, teaching people to develop and use critical thinking when considering choices.

The medical industry likes one-size-fits-all solutions, which works poorly. BMI are probably the most obvious issue, but it occurs across the board

This. According to the BMI chart i need to lose 100 pounds. I would have to lose a limb in order to lose 100 pounds, ive got maybe 30-40 pounds on my waste that need to leave, but i can really see the spare tire im lugging around being more than that.

BMI is actually fairly accurate unless you're built like a linebacker. Body fat percentage is of course much more accurate but is much harder to determine compared to BMI. I used to think the same thing, I was slightly overweight according to the BMI scale and I thought I only had 20 pounds to lose at most, 25lbs lost later I still have at least 10lbs more to go.

BMI is based on avg's. Had a skinny friend that couldn't gain weight no matter how hard he tried. He was always very low on the BMI. Meanwhile, I breath the air around a McDonalds I gain 10lbs. At my skinniest, I was 200lbs. I was always over the BMI or teetering on the "careful, fatty, you're pushing it" range. However, I leg press 1000lbs. I'm not exaclty built like a line-backer, but I do have overreactive insulin that makes it easier for me to gain both weight and muscle. Keeping the fat off and the muscle on is a chore, though.

Likewise, the ADA has the one-size-fits-all diet. For some folks that do well on the Atkins diet, lopping off the entire bottom part filled with grains works best for them. For others, cutting out some meat and focusing on grains works better.

A lot of the government is just focused on the inner 50% of the bell curve. But, that leaves the outer 25%'s on each side struggling wondering why they follow the recommendations and still end up fat or with a heart attack.

Some of this is push-back from commercial interests like soda distributors; the authors recognize that these sorts of behavioral efforts pose a threat to "economies that are built on excessive consumption."

I'm sure they're the most visible because they have the cash to make themselves heard, but I sincerely doubt that employees of pepsi-co make up the majority of people who have a problem with a government outlawing their food choices.

Z1ggy wrote:

This. According to the BMI chart i need to lose 100 pounds. I would have to lose a limb in order to lose 100 pounds, ive got maybe 30-40 pounds on my waste that need to leave, but i can really see the spare tire im lugging around being more than that.

I don't know you. Maybe you're right about yourself. But if you're like the vast majority of people who make that statement, you're fat. BMI sets a deliberately low bar to avoid this sort of problem - in men, it misses about a quarter of the people declared obese by more precise methods of quantifying fat. People like to claim they're too muscular and that throws off BMI - but they're not Chris Hemsworth with a little paunch, no matter how much we all want to be. One study asking people to match themselves to generic BMI silhouettes found that only 10% of obese people could do it correctly vs 80% for normal weight people.

the only visible effect of the recent massive federal cigarette tax hike at my job was that one guy quit for like two weeks and a few others now roll their own. then the company tried to annoy us into quitting by moving the smoking area really far away, but that didn't do anything either.

there's also this thing from our (shitty, overpriced) health insurance where they slightly reduce the outrageous premiums if you tell them all the bad things you're doing, but I refuse to participate in that because it's basically giving them a list of excuses to jack your rates even more or deny your claims.

If scientists would just, you know, follow the actual scientific method we'd be in far better shape. Instead, we see these observational studies published every other day in which conclusions are drawn and is picked up by the press and states as fact.

It's almost like "nutritional" science has created their own version of science which is based on theories instead of proven data. I really wish we'd see more metabolic ward based nutritional studies where variables are properly isolated instead of all of this food survey garbage.

Financially speaking, asking (or demanding for help) from the public can't work indefinitely. Costs will have to be absorbed somewhere by somebody.

It's better to do it now by taxing those people that want to have that "fuller life" so that support will be there for them when they demand the public for help by age 55+. Maybe "taxing" is the wrong word. It should be more like retirement medical fund for your inevitable health costs.

Two points in response: First, it is not necessarily true that less healthy living imposes net costs on the public when the government subsidizes medical treatment. People with unhealthy habits may have higher peak medical costs than people with healthy habits, but their lifetime medical costs may be lower because they die sooner.

Second, unconditional government subsidies to medical treatment are not a fact of nature. The government could choose not to spend that money.

There are well understood risk factors for things like Lyme disease and hantavirus, and many people have managed to change their habits to minimize risk. Faced with the risk of a noncommunicable disease, like cancer or heart disease, we don't tend to do nearly as well, even when the risks are equally well understood.

Well no. You are comparing something the TV provides scare stories about with a real scary eventuality. I say eventuality because most people will not be able to avoid both of these if they live long enough.

With fear of the moment on TV "OMG Hanta! I'd better not fly to the mainland and go to a US park or I'll get THE HANTA!!!!!" you do not have a real threat. With Lyme you have something that hits very few people so the TV can tell you a horror story that will most likely never hit the viewer. It is an immediate threat with very little actual risk, the average person's brain likes immediate threats, they are exciting, they also hate real risk. Our evolution has wired us to worry about immediate threats. So the TV likes to barf out scare pieces that are puffed up at best. "OMG flesh eating bacteria may be hiding in my glove compartment!". So the average person's brain gets that little tingle but doesn't have to waste calories thinking about a solution. "You will be killed on the road by someone just like you." would not be a popular news story.

To save calories the "average" person's brain has a way of dealing with big, real, long term problems. You may have seen it in the 5 stages of grief. Step 1: Denial. Step 2: Anger. Step 3: Bargaining. Step 4: Depression.Step 5: Acceptance.

These are not used for times when a person is told they are dying. Denial works just as well on your life style killing you as it does on global warming. Tell the average person that their child did something horrible and I'm betting you will see a step 1 response. Bargaining? "Well if we sequester the CO2 for the next generation to deal with, we'll be fine" sounds about like "Well if I quit smoking by 50, I'll be fine.".People may not go through all 5 stages, they may linger on one or skip a few they may even combine steps. In the end it is a generalized way that "average" people deal with big problems. This is also a big reason that well all get old an die. The aging process is a long term threat and over the average person's life you can watch them going through the steps. The other big reason is that most people belong to death cults which give them an imaginary parachute. No one on average just wants to deal with the horror of ending.

So we have an problem with average people not liking to think and this causes problems or kills them or others. People who do not think can be engineered easily.

The next issue is that people do not like to be part of the problem. Take an auditorium of people and tell them that you are going to remove all drunks from the roads and they will respond positively due to the effort to create that group of villains ("WTF do you mean 'one for the road' Grandpa?!"). Tell them that you will remove all inattentive drivers from the road, like those who commute in the passing lane or talk on a cell phone while driving and you will not get the same response, even if inattentive/distracted driving is a bigger threat than drunks. The average person in the group is probably a member of one of the problem groups. So you do want to invest time to villainize the problem and the people who indulge in it at a rate where the average person never feels they are part of the problem. The average person will thank you in the end when there is a new villain to hate.

Banning smoking in public places is one thing, because there are defined health consequences for people other than the user. This is a compromise between the rights of the smoker, with the rights of the other people in the public space.

Placing limitations on sugared drinks is something else entirely. Whether someone chooses to drink a soda or not has no impact on anyone but themselves. They have the right to make that choice.

If we intend to eliminate every root cause that could result in higher health care costs down the road, we better prepare ourselves to curtail everything significant in life, including sources of stress like work or politicians. Actually, if you want to maximize those cost savings, why not just kill us all now before we get old and expensive?

For example, to get people more exercise, the authors suggest we might "consider making the elevator a less appealing option by increasing the effort required to use it. For example, slowing down the speed at which elevator doors close, thus increasing the journey time, increases stair use."

That pisses me off. Yes, making it more difficult to access things that are bad for individuals is a good idea, but making access to things meant to make buildings more accessible to people with disabilities is one of the most poorly thought out suggestions this author could make, especially after points made earlier in the article. Accessibility for people with physical disabilities is hard enough without pissant things like artificially slowed doors/elevators.

Banning smoking in public places is one thing, because there are defined health consequences for people other than the user. This is a compromise between the rights of the smoker, with the rights of the other people in the public space.

Public places like parks and streets? Smoke's PPM outdoors from a smoker approaches 0 threat to anyone. Laws against that, are just attacks on smokers because they are an accepted villain and it is OK to hate them and to make their life worse. When you cannot smoke in a tobacco store legally, you have reached stupid. Laws against smoking in confined spaces with non-smokers, who cannot go elsewhere, are there to protect them.

Obesity IMO would probably be the easiest problem to address currently. But it still has its draw backs. My wife recently started a diet and we were both completely amazed trying to count calories, with how bad the state of food prices are. Healthier options tend to be significantly more expensive than the unhealthy ones. And this tends to effect people who are on strict budgets and have to stretch their dollar the most. And Also the content in some of the food options, Two double cheeseburgers from mcdonalds would have thrown her over her calorie limit for the day.

As far as smoking/drinking goes. I look at it like I look at the war on drugs. Usage has been around as long as humans have, we've been finding ways to smoke tobacco, get drunk and get stoned for over a milennia. It is NOT going to go away no matter how much money you throw at it. It is up to the user's preferences IMO.

The problem is the grey line between deterring bad behavior and violating people's civil liberties. Ex: NYC actions against tobacco (make it more expensive, more difficult to smoke, thus smokers pay a higher price) vs soda (making it less available, thus taking the choice away?)

I don't know much about the NYC soda law. But, aren't there a crazy amount of loopholes a consumer can use to get around this? For example, free 16oz refills, pay for 2 16oz drinks, etc. I don't see how your choice can get taken away. If you want to really drink a lot of soda, there should be lots of options.

Its true that the soda ban is not a complete ban, and it may never be. My point, however, is that instead of making something more difficult or expensive, the NYC government has taken something away.

However, it could be vastly improved by education beginning in schools and, especially, teaching people to develop and use critical thinking when considering choices.

I do think education is a really big factor, but not the kind of education that has been pushed. Don't teach people what to choose, teach them how to choose.

For example, you could make it a required element of high school core curriculum, that all students must learn how to cook themselves simple meals from scratch. How to cook a chicken breast. How to make a stew. Even how to make a cheeseburger, with fresh ingredients. This by itself would go a really long way, I think, because it's one of those things where if you are never taught how, the anxiety of ruining your dinner and wasting your time, and just the general inertia of not wanting to tackle your own ignorance, means you'll probably end up eating fast food and prepared meals the rest of your life.

On the matter of the cigarette tax, the French government has been milking smokers for decades under the pretense of fighting smoking. A pack costs around 6 euros (>$7.50) and this has little effect on tobacco consumption (~30% smokers).